Saturday, March 31, 2012

Those plagued with gorgeous eyes are always worried they'll eventually inherit a disease in payment for years of compliments. Their fears are not completely unwarranted, yet they are very easily reduced with proper care and guidance.

If you refer back to my blog on March 24, 2012 "My eyes were blue, now they're green..", you'll learn a little about the thickness of an iris (colored part of the eye) contributing to the overall color. As previously stated the more layers of pigment we have in our iris the darker the color. Hence a lighter colored eye will have less layers of pigment, translating into less protection from UV harmful rays.

As light enters the eye there stand several structure to protect the delicate, sensitive retina (the sensory tissue that picks up all images). Think of old fashioned non-digital cameras, remember if we opened the camera the light would ruin the film, making you the most horrible person for destroying the baby's first birthday pictures. The retina in the eye is that sensitive to extreme light exposure, even for just minutes. Now thankfully we have some intelligent designing that wouldn't allow that to happen. The iris has the ability to contract and dilate depending on our light settings which helps, keep in mind the darker the iris the more light is blocked regardless of pupil size. Then there is the lens (right behind the iris) made of a cystalline material that is programmed to absorb all harmful UV rays. Later in life it does get yellower (like windows in an old house) developing into cataract. Every single person in this world that walks outside is developing cataract, now consider the amount of light going through a lighter iris. They can develop cataract a few years earlier then the brown eyes. Are we all following the thread? UV light is the culprit and all those structures stand together to protect the retina, some are better defenders (browns) then others (green/blue). The only man-made object to put everyone on an even playing field is a UV protected pair of sunglasses (transition lenses are wonderful too). We've even managed to put UV protection on clear lenses and contact lenses, however they aren't as effective as a UV blocking pair of sunglasses.

The answer to the question is true without protection, but false with some cool shades.

Friday, March 30, 2012

The conjunctiva (thin transparent skin that covers the white of the eye, you can move it with your finger if you so dare) and sclera (the actual white harder structure that forms the eye) may both be affected and change colors for various reasons. Even though they look like one complete structure it's important for this lesson to understand that they are separate and can be effected differently with varying prognosis.

Let's take the conjunctival tissue first, explain it's similarities to skin and how it reacts to the exterior elements. As previously mentioned, it's loose on the surface of the eye and is completely transparent. It's histological formation is just like the skin all over our bodies, thankfully not exactly otherwise we'd be transparent with all our organs in plain sight, yikes! Still it reacts to sun just like our skin, it gets darker (more yellow) and sometimes thicker. I'm sure you've seen some form of this amongst your friends or family, a sectoral (specific spot) area in the eye is yellow, thicker with splashes of red. We call them pinguecula (smaller yellow bump) and pterygiums (larger yellow bump getting close to the corneal center of the eye). The sun is mostly to blame for their existence. Therefore UV protection (aka sunglasses) is extremely important to prevent their formation. Still both are quite harmless in the realm of health, both can be surgically removed for cosmetic or visual reasons.

Now the sclera is a more bone-like structure, it's how the eye maintains it's round, firm shape. This is where we get the milky white color, actually the sclera is a hue of blue but it's perceived as white to us. When this appears to yellow consuming the whole eye, it leads us to believe there may be systemic involvement. We consider the patient may be suffering from problems in the liver, pancreas, spleen or blood (usually sickle cell anemia). In most cases we highly advice blood work by the patient's primary care physician (your regular doctor) in order to rule out any serious life threatening diseases. Eyes are an amazing tool, as optometrist we can connect your entire body's health to small parts of your eye. Some say eyes are the window to the soul, I say they are the window to your health. Get your eyes checked every year and you'll learn how preventive medicine can really help.

Thursday, March 29, 2012

Latisse (bimatoprost ophthalmic solution) is a new drug introduced in 2009 to enhance the growth and thickness of eyelashes, must be prescribed by your eye care professional. Brilliant idea right?! I remember the first time I saw the commercial, flashbacks to optometry school where I had thought of the idea myself. Allow me to break down the formation of this wonderful product in order for you to understand my unearned credit of inventing this product years earlier.

Bimatoprost (Latisse) is an prostaglandin analog meaning it's a like a glaucoma medication the optometric world has been using for many years. This subset of drugs used to treat glaucoma (it lowers the pressure of the eye to reduce risk of optic nerve damage) has interesting side effects. You guessed it, the side effect is enhanced eyelash growth. Therefore you can imagine as students when we all learned about this glaucoma drop and it's magical side effect, instantly some of us thought we'd apply some to our own eyelashes and watch them grow to their fuller potential. Allergan must have crept into our dreams and decided to do just that, bottle the side effect (keep in mind it's not a glaucoma medication but a close cousin). The plain truth is Latisse works and works well to make your eyelashes grow long, thick and "get out of a speeding ticket" beautiful. Results will be seen within one month of continuous treatment.

Caution: This is the part you really listen. Prostaglandins have other side effects as well. The area where the medication is applied (which is ONLY the upper lid once you've cleaned your face really well, removed contact lenses) can become darker. Yes your skin can change color and become darker, seen mostly in fair/light skinned patients. Another really important point, if your eyes are lighter in color (esp. hazel and green) studies have shown the color of your iris will darken also. Irreversible darkening of your eye, now you'll have brown eyes. A very important warning and risk factor. Other contraindications are for patients that may have had surgery (cataract removal mostly) or history of macular edema, the prostaglandin can bring back some inflammation. I highly suggest reading the entire information packet online for Latisse before deciding if the product will be a good match, along with speaking with your eye doctor. Inform your eye care professional if there is anything odd once you've started treatment. We don't want swelling, itch or extreme redness in the eye.

Tuesday, March 27, 2012

Floaters! That's the term we use to describe these strange spots we see in the visual field. Often times they are shaped like transparent worms, like cells we've seen in biology class, or cobwebs floating around in a slow rhythmic motion. They seem to appear more readily in blank monochromatic (one color) backgrounds. For instance when you stare into a cloudy sky, a white ceiling or maybe even your bathroom tiles they will appear. Try it at home, I bet you'll see tons and never be able to ignore their existence ever again. As common as they are (seen eventually by 100% of patients before age 70), they are mostly completely harmless.

The vitreous humor (the fluid inside the eye that helps keep the shape of the eye, nutritious too) is mostly transparent when we are born. As we age that gelatin changes biological properties, becoming a bit more liquefied and creating collagen structures that are visible and no longer transparent. Those strings of collagen will cast shadows on the retina (sensory tissue lining the inside of the eye (film in the camera), very important) and allow your eyes to perceive images that are oddly shaped. Therefore the concern shouldn't be too high.

Still as with everything we've discussed, certain floaters aren't normal and may be caused by injuries, rubbing the eyes too much, or inflammation/infections. They are usually abundant, darker and may be seen with flashes of light (that light will be seen for more then 3-5 minutes...it's not subtle). This is the point where you don't wait, you go to an eye care professional to ask about those extra floaters or possible flashes as soon as possible. This could be a more serious, vision threatening issue...stead fast attention is needed in this scenario. If you're still unsure about which you may experience, please email me.

Sunday, March 25, 2012

That single tear on a baby's face is so cute, just hanging on to the lid until it plummets to it's destination of chubby baby cheek. It's hard to resist and not wonder if it's normal crying tears or maybe something else is happening. I get this question often from new parents with their not quite one year olds babies.

Much like with adults some times we just get something in our eyes which causes reflex tearing (different from purposeful sad/happy tears). The temperature or windy days may also cause this reaction. However I know this situation is special because it happens randomly, usually in the same eye for months. When babies are young their bodies are changing so rapidly that certain parts, like the tear duct membrane (the area where we usually find eye boggies) isn't completely open. That prevents the tear from draining into our lacrimal system down to the throat. The duct (like a tube) could also be really narrow. Regardless in almost all cases these issues will resolve themselves with time, as the membrane opens or duct dilates. Still there are some ways we can help the process by massaging the tear duct. Not something you should request next time you see your masseuse, it's only for babies. The parent should place a clean wet (luke warm water) cloth over the tear duct area, massaging it for maybe 10 seconds about three times a day for a week. Keeping the area clean and promoting dilation. If the baby does get swelling or redness around that area with yellow discharge make sure to take the baby to a Pediatric Optometrist or Ophthalmologist. In extreme cases the Ophthalmologist (they are surgeons, we are primary care) might decide to surgically open the duct if the earlier methods haven't work and the baby keeps getting infections. We can leave that decision to them. Good to be aware of normal vs. not normal. Feel feel to send pictures or videos, I'll do my best in pointing you in the right direction.

Saturday, March 24, 2012

Changing eye color! Now this is a great question posed to me by a good friend. Great question because part of the answer is....well we don't really know, however there are theories. The way the iris (colored part of the eye) is constructed is based on layers of pigment (color, what makes our skin either lighter or darker). The more layers we have the darker our iris appears to the world. So it's not like colors are picked, it's more like layers. For example with babies, sometimes they appear to have blue eyes when they are born but as time passes the iris will darken...just like the skin might be getting darker too. All this means is the baby is producing more pigment, a very normal development.

Now you may have guessed my good friend isn't a baby, she's a full grown adult woman. Therefore this questions is still interesting, can we still produce more or less pigment as we age? Maybe, it's a possible theory and this change in the iris happens in a least 10% of the aging population (mostly light eyes, sorry browns). Yet there is another reason that's possible too, mechanical rubbing on the iris. Meaning...something is rubbing on the iris so that layers start to decrease creating a lighter iris. The rubbing is not always normal, could be a space issue caused by inflammation or physical changes in the size of the eye. My best advice would be to rule out these causes by getting a complete eye exam including dilation. Make sure your doctor measures the pressure of your eye (glaucoma test), as this may also be affected. Don't fret now, this doesn't mean anything until we get all the test done.

Friday, March 23, 2012

Astigmatism seems to sound like a really scary word in exam room to most people. My patients tell me they have it like it's the plague or maybe some recently discovered disease that will absolutely destroy mankind. I hold back some laughter and explain it's just another reason they need to wear glasses. There are many terms to describe why patients need correction (ei. glasses or contacts) in order to see better. This is simply another reason, the eye's surface is simply more curved then it should be. Once light enters the eye, it's bent in funny shapes to trick your eye into seeing the world in a odd shape...more specifically letters seem distorted. The letter T will seem like a cross or an F, something lenses will aid in refocusing. Here are symptoms, in case you might be another victim of this harmless, easy to fix problem.

Patient: "I can't see at night anymore, I'm going night blind. The glare from cars annoys me and I feel like the sun is sitting in my eyes when it's really sunny. Also I hate wearing sunglasses because everything goes more blurry but then the sun is bugging me, I'm stuck. And...I lose my spot every time I read a book or look at a computer...it's not blurry really but sorta. What's wrong with me, am I gonna live?"

Me: "Yes, it's probably Astigmatism...let's investigate further..."

See and Be Seen! at Eyed LA Optometry in Brentwood, West Los Angeleswww.eyedla.com